Provider First Line Business Practice Location Address:
30326 9TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-581-7084
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2026